Provider Demographics
NPI:1164587705
Name:STREETS, MARK LLOYD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LLOYD
Last Name:STREETS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HUMBOLDT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9199
Mailing Address - Country:US
Mailing Address - Phone:530-891-6521
Mailing Address - Fax:
Practice Address - Street 1:1660 HUMBOLDT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9199
Practice Address - Country:US
Practice Address - Phone:530-891-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL11878Medicare ID - Type Unspecified